Clinical Endoscopy

Original Article

Value of Fecal Calprotectin Measurement During the Initial Period of Therapeutic Anti-Tubercular Trial: Hyeong Ho Jo, Eun Young Kim, Jin Tae Jung, Joong Goo Kwon, Eun Soo Kim, Hyun Seok Lee, Yoo Jin Lee, Kyeong Ok Kim, Byung Ik Jang, the Crohn’s and Colitis Association in Daegu-Gyeongbuk; Clin Endosc 2022;55(2):256-262. Published online November 5, 2021; DOI: https://doi.org/10.5946/ce.2021.061

Background
/Aims: The diagnosis of intestinal tuberculosis (ITB) is often challenging. Therapeutic anti-tubercular trial (TATT) is sometimes used for the diagnosis of ITB. We aimed to evaluate the changing pattern of fecal calprotectin (FC) levels during TATT in patients with ITB.
Methods
A retrospective review was performed on the data of 39 patients who underwent TATT between September 2015 and November 2018 in five university hospitals in Daegu, South Korea. The analysis was performed for 33 patients with serial FC measurement reports.
Results
The mean age of the participants was 48.8 years. The final diagnosis of ITB was confirmed in 30 patients based on complete mucosal healing on follow-up colonoscopy performed after 2 months of TATT. Before starting TATT, the mean FC level of the ITB patients was 170.2 μg/g (range, 11.5-646.5). It dropped to 25.4 μg/g (range, 11.5-75.3) and then 23.3 μg/g (range, 11.5-172.2) after one and two months of TATT, respectively. The difference in mean FC before and one month after TATT was statistically significant (p<0.001), and FC levels decreased to below 100 μg/g in all patients after one month of TATT.
Conclusions
All ITB patients showed FC decline after only 1 month of TATT, and this finding correlated with complete mucosal healing in the follow-up colonoscopy after 2 months of TATT.

Citations

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Fábio Pereira Correia, Luísa Martins Figueiredo, Luís Carvalho Lourenço, Sofia Santos, Rita Theias Manso, David Horta
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Daya Krishna Jha, Mythili Menon Pathiyil, Vishal Sharma
Indian Journal of Gastroenterology.2023; 42(1): 17. CrossRef
Fecal Calprotectin as a Surrogate Marker for Mucosal Healing After Initiating the Therapeutic Anti-Tubercular Trial
Satimai Aniwan
Clinical Endoscopy.2022; 55(2): 210. CrossRef

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Focused Review Series: A Perspective: Endoscopy and Imaging in Inflammatory Bowel Disease

Computed Tomography Enterography for Evaluation of Inflammatory Bowel Disease: Min Jung Park, Joon Seok Lim; Clin Endosc 2013;46(4):327-366. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.327

Abstract PDF PubReader ePub

Computed tomography enterography (CTE) has become a main modality for the evaluation of inflammatory bowel disease (IBD). It simultaneously offers visualization of the small bowel and extraintestinal status, which is helpful for diagnosing IBD. Crohn disease has long segmental enhancing wall thickening related with the eccentric longitudinal distribution. In addition, mural stratification, fibrofatty proliferation, positive comb sign by increased mesenteric vascularity and internal/perianal fistula are characteristics of Crohn disease and can be identified on CTE. Short segmental inflammatory wall thickening and the central low attenuated lymph nodes are favorable CT finding of intestinal tuberculosis. A geographic, relatively large, and deep penetrating ulcer with bowel wall thickening and mural hyperenhancement in ileocecal area are characteristics of intestinal Behcet disease. Each of CTE findings for the IBDs is helpful for differential diagnosis. The main disadvantage of this technique is the requisite radiation exposure of patients, particularly in young patients. However, recent development of advanced CT techniques is promising for radiation dose reduction without compromising diagnostic image quality.

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Case Report

Cecal Fecaloma Due to Intestinal Tuberculosis: Endoscopic Treatment: Sun Moon Kim, Ki Hyun Ryu, Young Suk Kim, Tae Hee Lee, Euyi Hyeog Im, Kyu Chan Huh, Young Woo Choi, Young Woo Kang; Clin Endosc 2012;45(2):174-176. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.174

Abstract PDF PubReader ePub

Colorectal fecaloma is a mass of accumulated feces that is much harder in consistency than a fecal impactation. The rectosigmoid area is the common site for fecalomas and the cecum is the most unusual site. Diagnosis is usually made by distinctive radiographic findings of a mobile intraluminal mass with a smooth outline and no mucosal attachment. Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation. When conservative treatments have failed, endoscopic procedures or a surgical intervention may be needed. We report here that a cecal fecaloma caused by intestinal tuberculosis scar was successfully removed by endoscopic procedures.

Citations

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Obstructive Fecalomas in an Infant Treated with Successful Endoscopic Disimpaction
Risa Kanai, Kengo Nakaya, Koji Fukumoto, Masaya Yamoto, Hiromu Miyake, Akiyoshi Nomura, Susumu Yamada, Akihiro Makino, Hideto Iwafuchi, Naoto Urushihara, Georg Singer
Case Reports in Pediatrics.2021; 2021: 1. CrossRef
Cecal fecaloma: A rare cause of right lower quadrant pain
Brian T. Wang, Stefanie Y. Lee
European Journal of Radiology Open.2019; 6: 136. CrossRef
Gastrointestinal Tuberculosis
Eric H. Choi, Walter J. Coyle, David Schlossberg
Microbiology Spectrum.2016;[Epub] CrossRef
Successful Removal of Hard Sigmoid Fecaloma Using Endoscopic Cola Injection
Jong Jin Lee, Jeong Wook Kim
The Korean Journal of Gastroenterology.2015; 66(1): 46. CrossRef
Ileal Fecaloma Presenting with Small Bowel Obstruction
Ha Yeong Yoo, Hye Won Park, Seong-Hwan Chang, Sun Hwan Bae
Pediatric Gastroenterology, Hepatology & Nutrition.2015; 18(3): 193. CrossRef

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A Case of Colon Cancer Coexisting with Colonic Tuberculosis: Jae Myung Cha, M.D., Joung Il Lee, M.D., Jae Won Choe, M.D., Kwang Ro Joo, M.D.,Sung Won Jung, M.D., Hyun Phil Shin, M.D., Woo Young Hew, M.D. and Suk-Hwan Lee, M.D.*; Korean J Gastrointest Endosc 2008;37(5):369-373. Published online November 30, 2008

Abstract PDF: Patients with chronic inflammatory bowel disease have a potential risk for developing colorectal cancer. Simultaneous occurrence of tuberculosis and colon cancer at the same segment of the colon has been reported; however, there is little causal relationship between the two disorders. The occurrence of tuberculosis and an adenocarcinoma at the same segment of the colon may lead to a histological misdiagnosis of either lesion. Furthermore, it may be difficult to determine the correct radiological cancer staging before surgery, as tuberculous lymphadenitis may be misinterpreted as a lymph node metastasis of colon cancer. We report here a rare case of colon cancer coexisting with colonic tuberculosis at the same segment of the colon. In addition, we review the clinical characteristics of reported patients with similar conditions following a computerized search of KoreaMed and PubMed. (Korean J Gastrointest Endosc 2008;37:369-373)

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Intestinal Tuberculosis with a Duodenal Fistula: Eun Bum Park, M.D., Yoon Tae Jeen, M.D., Jae Hong Ahn, M.D., Sang-jun Suh, M.D., Sun Jae Lee, M.D., Nark-Soon Park, M.D., Bora Keum, M.D., Yeon Seok Seo, M.D., Yong Sik Kim, M.D., Hoon Jai Chun, M.D., Hong Sik Lee, M.D., Soon Ho Um, M.D., Sang Woo Lee, M.; Korean J Gastrointest Endosc 2007;35(5):346-350. Published online November 30, 2007

Abstract PDF: Intestinal tuberculosis is a common disease of extrapulmonary tuberculosis. A diagnosis of intestinal tuberculosis is difficult as the symptoms and laboratory findings are not specific for the disease. Intestinal tuberculosis may cause various complications, such as intestinal obstruction, intestinal perforation, intraabdominal abscess, intestinal hemorrhage and fistula formation. A duodenal fistula caused by tuberculosis is an especially rare condition. We experienced a case of intestinal tuberculosis with a duodenal fistula as a complication. The patient was a 25- year-old man that presented with weight loss and diarrhea. Esophagogastroduodenoscopy showed a deep ulcerative lesion on the third portion of the duodenum with a fistula opening. A histological finding revealed granulomatous inflammation with multinucleated giant cells. In addition, the result of a Tb PCR assay was positive. After two months of treatment with the appropriate medication, the symptoms improved and the fistula has closed completely. We report the case with a review of the literature. (Korean J Gastrointest Endosc 2007;35:346-350)

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A Case of Duodenal Fistula Caused by Intestinal Tuberculosis: Du Young Kwon, M.D., Hea Won Park, M.D., Sang Hyuck Seo, M.D., Byung Kuk Jang, M.D., Jun Young Hwang, M.D., Jung Min Lee, M.D., Yun Seok Hong, M.D., Kyung Sik Park, M.D., Kwang Bum Cho, M.D., Jae Seok Hwang, M.D. and Sung Hoon Ahn, M.D.; Korean J Gastrointest Endosc 2004;28(3):131-135. Published online March 31, 2004

Abstract PDF: Intestinal hemorrhage, fistula formation, and intestinal obstruction are the common complications associated with intestinal tuberculosis. However, duodenal fistula due to intestinal tuberculosis is very rare. We experienced a case of 26-year-old woman with a fistula in the duodenum referred to our hospital due to abdominal pain. Esophagogastroduodenoscopy showed a fistula at the duodenum with lymph node. After 2 months of anti-tuberculous medication, abdominal pain was improved and fistula size decreased. We report a case of fistula caused by duodenal tuberculosis. (Korean J Gastrointest Endosc 2004;28:131⁣135)

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A Case of Secondary Amyloidosis Associated with Intestinal Tuberculosis: Jungkwon Kim, M.D., Seung-Jae Myung, M.D., Jungjoon Choi, M.D., Gideog Kim, M.D., Dongryoul Oh, M.D., Sujin Koh, M.D., Won-Jang Kim, M.D., Jintae Park, M.D., Ginhyuk Lee, M.D., Suk-Kyun Yang, M.D., Weon-Seon Hong, M.D., Jin-Ho Kim, M.D., Young-Il Min, M.D; Korean J Gastrointest Endosc 2003;27(4):244-248. Published online October 31, 2003

Abstract PDF: The secondary amyloidosis (AA type), a complication of inflammation or infection, is caused by the deposition of serum amyloid protein A in various organs. The clinical manifestations of amyloidosis are various according to involved organs. The gastrointestinal tract is one of the commonly affected organs. However, the endoscopic findings of gastrointestinal amyloidosis are nonspecific, and symptoms are diverse. Hepatic involvement of amyloidosis rarely leads to hepatic dysfunction, threfore is not a clinical concern. We report a 54-year-old women with intestinal tuberculosis whose major symptom was watery diarrhea lasting several months. The amyloid deposits were histologically proven in the rectum of which mucosa showed redness and swelling endoscopically and hepatic involvement of amyloidosis was suspected on abdominopelvic CT scan. After anti-tuberculosis medication for 6 months, abdominopelvic CT scan showed resolution of hepatic involvement and colonoscopy revealed improvement of redness and loss of vascularity of the rectum.

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The Diagnostic Value of Polymerase Chain Reaction in Intestinal Tuberculosis: Tae Kyu Lee, M.D., Young Hwan Kim, M.D., U Im Chang, M.D., Eun Jung Jun, M.D.,; Korean J Gastrointest Endosc 2003;26(2):79-83. Published online February 28, 2003

Abstract PDF: Background
/Aims: It is quite difficult to differentiate intestinal tuberculosis from Crohn's disease because of the similarities of their clinical and pathological features and low detection rate of acid fast bacilli. The diagnostic value of PCR has been studied in pulmonary tuberculosis, tuberculous pleuritis and meningitis, but few reports were made in cases of intestinal tuberculosis. The aim of this study is to evaluate the diagnostic value of PCR in intestinal tuberculosis. Methods: The subjects, a total of 70 cases are composed of clinically diagnosed intestinal tuberculosis, Crohn's disease and intestinal Behcet's disease. We performed PCR with paraffin-embedded intestinal tissue to detect the DNA of Mycobacterium Tuberculosis and the data was analyzed. Results: The positive rate of PCR for Mycobacterium Tuberculosis was 9.8% (4/41) in intestinal tuberculosis, 0% (0/29) in Crohn's disease, and 0% (0/3) in intestinal Behcet's disease. The granulomas were not found in 50% (2/4) of the PCR positive intestinal tuberculosis cases. Conclusions: We were not able to find evidences to prove the excellent value of PCR assay in making differential diagnosis of intestinal tuberculosis from other granulomatous diseases. But it might be helpful in detecting cases of intestinal tuberculosis which were not pathologically or microbiologically confirmed. (Korean J Gastrointest Endosc 2003;26:79⁣83)

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십이지장암으로 오인된 비후형 십이지장 결핵 1 예 ( A Case of Hypertrophic Form of Duodenal Tuberculosis Mimiking Duodenal Cancer ): Korean J Gastrointest Endosc 2001;23(1):36-40. Published online November 30, 2000

Abstract PDF: The prevalence of intestinal tuberculosis has been markedly decreased with the development of antituberculoug chemotherapy, improved economic conditions, preventive medicine and early detection and treatment of pulmonary tuberculosis. An even more impressive resurgence of pulmonary and extrapulmonary tuber culosis has been seen in recent years among persons infected with the human immunodeficiency virus. The most common signs of infeshna1 tuberculosis is the ileocecal region, and duodenum is a rare site. Symptoms and signs of duodenal tuberculosis are nonspecific. The gross pathologic appearance of the duodeznal tuberculous lesions has to its traditional categoriration into three farms. 1) ulcerative, 2) hypertrophic, and 3) ulcerohypertrophic (mixed). Hypertrophic lesions of the duodenal tuberculosis should be differentiated from duodenal adenocarcinoma and lymphoma. We herein report a case of duodenal tuberculosis presenting as intraluminal protruding mass in gastroduodenoscopy and multiple intraabdomina1 lymphadenopathy on abdominal CT. We have confirmed the duodena1 tuberculosis by endoscopic biopsy, and review the current literatures. (Korean J Gastroluetest Endosc 2001;23:30-40)

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증례 : 식도 위장관 ; 결핵성 장염으로 오진된 Crohn 병 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Crohns Disease Misdiagnosed as Intestinal Tuberculosis ): Korean J Gastrointest Endosc 1998;18(6):945-950. Published online November 30, 1997

Abstract PDF: Crohn's disease is a rare inflammatory bowel disease requiring a differential diagnosis with intestinal tuberculosis in Korea. There have been several problems in the diagnosis of Crohn's disease due to the much higher incidcnce of intestinal tuberculosis and the clinical similarities between the two diseases. Therefore, in many cases, treatment involveed anti-Tb drugs based upon empirical diagnosis, This study presents a case of Crohn's disease treated with anti-Tb drugs for about 9 months after intestinal tuberculosis was misdiagnosed. (Korean J Gastrointest Endosc 18, 945-950, 1998)

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증례 : 식도 위장관 ; 결핵성 임파선염을 동반하고 상하부 장관을 광범위하게 침범한 장결핵 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Intestinal Tuberculosis Extensively Involving the Upper and Lower Intestinal Tract , Accompanied by Tuberculous Lymphadenitis ): Korean J Gastrointest Endosc 1998;18(3):408-415. Published online November 30, 1997

Abstract PDF: The prevalence of intestinal tuberculosis has been markedly decreased with the development of anti-tuberculous chemotherapy, preventive medicine, vaccinations, early detection and treatment of pulmonary tuberculosis, and improved eeonomic conditions. Nowadays, intestinal tuberculosis is a disease that should be differentiated from the inflammatory bowel diseases such as Crohn's disease and ulcerative colitis, Behcet's disease, and colon cancer and amebic colitis. This disease also has a new clinical significance in that it has an increased infection rate and unfavorable outcomes in patients infected by HIV or in those who undergo organ transplantation or receive immunosuppressive agents. Tuberculosis of the duodenum was a rare disease and was not reported in the last decade. Moreover Intestinal tuberculosis extensively involving the small bowel including the duodenum and colon was very rarely reported in the various relateid literature. Recently we experienced a case of advanced intestinal tuberculosis involving the duodenum, jejunum, ileum, and colon accompanied by tuberculous cervical and abdominal lymphadenopathies, in a 49-year-old woman who manifested profound general weakness, diarrhea, and marked weight loss. She was diagnosed pathologically by upper gastrointestinal endoscopy, colonoscopy, and fine needle aspiration cytology as well as by roentgenologic examination. The patient was given antituberculous medication which resulted in dramatic clinical improvement. In this report, we present this case with review of the related literature. (Korean J Gastrointest Endosc 18: 408-414, 1998)

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증례 : 식도 위장관 ; 장결핵에 의한 장중첩증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Intussusception Induced by Intestinal Tuberculosis ): Korean J Gastrointest Endosc 1998;18(1):99-105. Published online November 30, 1997

Abstract PDF: Although intussusception is primarily a disease of children, about 5 to 10 percent of cases occur in adults. The underlying causes of adult intussusception are tumor, postoperative complication, local bowel ischemia, abnormal motility and rarely intestinal tuberculosis. Recently, we experienced a 62-year-old man with intussusception underlying pulmonary tuberculosis. The postoperative pathologic finding was intestinal tuberculosis. For its rarity, we report this case with review of literatures. (Korean J Gastrointest Endosc 18: 99-104, 1998)

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증례 : 식도 위장관 ; 대장암으로 오인된 장결핵 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Intestinal Tuberculosis Presenting a Tumor-like Mass ): Korean J Gastrointest Endosc 1997;17(4):569-573. Published online November 30, 1996

Abstract PDF: Intestinal tuberculosis is a secondary infection from swallowing of infected sputum of pulmonary tuberculosis patient. The diagnosis is usually difficult there are no specific radiological signs and false negatives are often found in biopsy material obtained by colonoscopy since the process is mainly submucous. A lesion which is visualized on colonoscopic examination is rather confusing in that one will find a firm tumor mass occupying the lumen of the bowel which is most suggestive of carcinoma. We experienced a case of intestinal tuberculosis presenting a ulcerofungating mass occupying the lumen of the ascending colon, confirmed by colonoscopc biopsy in a 36-year-old man. He received anti-tuberculosis medication far 18months. The mass initially found totally disappeared as shown by a follow-up colonoscopy. (Korean J Gastrointest Endosc 17: 569-573, 1997)

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